title: Purulent pericarditis secondary to community-acquired, methicillin-resistant Staphylococcus aureus in previously healthy children. A sign of the times?
abstract: BACKGROUND
  Purulent pericarditis secondary to community-acquired, methicillin-resistant Staphylococcus aureus (CA-MRSA) is a potentially lethal infection that has yet to be described in the pediatric population. Only four cases of purulent pericarditis secondary to CA-MRSA have been described in the English literature, all of whom were adults.
  
  
  OBJECTIVE
  We report on the first two pediatric cases of purulent pericarditis secondary to CA-MRSA to increase awareness of this potentially fatal condition.
  
  
  METHODS
  Clinical data were obtained from an 8-year-old male patient and a 7-month-old female patient, both previously healthy, who presented to our hospital for treatment of severe shock and multiorgan failure. Literature review was performed using MEDLINE and Cochrane databases. Pulsed-field gel electrophoresis was performed to confirm the organism type.
  
  
  RESULTS
  Our previously healthy patients presented with refractory shock and were found to have purulent pericarditis with tamponade secondary to CA-MRSA. Both patients required emergent pericardiocentesis and surgical pericardial debridement. Isolates from both patients were found to be MRSA USA type 300, a common type of CA-MRSA that has become the most frequent cause of skin and soft tissue infections in the United States.
  
  
  CONCLUSIONS
  Purulent pericarditis survival hinges upon early empiric antibiotic therapy targeting resistant Staphylococcus, rapid diagnostic efforts, and expeditious pericardial drainage when diagnosed. An aggressive multidisciplinary approach provided for complete recovery in both cases, and both children were discharged with normal cardiac function. These two cases emphasize the need for consideration of CA-MRSA presenting with purulent pericarditis as an etiology for refractory shock.
authors.affiliation: Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio 43205, USA. jeffrey.lutmer@nationwidechildrens.org
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lutmer
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Yates
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Bannerman
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Marcon
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Karsies
mesh_terms: D002305:Cardiac Tamponade / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010493:Pericarditis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D013997:Time Factors